Provider Demographics
NPI:1164525481
Name:ATLANTIC CARDIOLINK
Entity Type:Organization
Organization Name:ATLANTIC CARDIOLINK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GADODIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-952-9009
Mailing Address - Street 1:1305 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3223
Mailing Address - Country:US
Mailing Address - Phone:321-952-9009
Mailing Address - Fax:321-952-9005
Practice Address - Street 1:1305 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3223
Practice Address - Country:US
Practice Address - Phone:321-952-9009
Practice Address - Fax:321-952-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE9043Medicare ID - Type Unspecified